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Tramadol and SSRI interaction — GPhC CRA MCQ

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ModerateCNS TherapeuticsTramadol and SSRI interactionGPhC CRA

A patient taking fluoxetine 20 mg daily presents a new prescription for tramadol 50 mg four times daily for back pain. She has no known drug allergies and asks to collect it immediately. What is the most important interaction to flag?

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Correct answer: A — Increased risk of serotonin syndrome and seizures

Tramadol has serotonergic activity and can lower seizure threshold. Fluoxetine is also serotonergic and has a long half-life, so the combination can increase the risk of serotonin syndrome and seizures. The pharmacist should flag the interaction and seek a safer analgesic plan where appropriate. Counselling should include warning symptoms such as agitation, sweating, tremor, diarrhoea and confusion if the combination is used.

Reference: https://www.pharmacyregulation.org/students-and-trainees/pharmacist-education-and-training/registration-assessment